Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress 2023 EHA Congress 2023 ASCO Annual Meeting
Clinical Collections
Advances in Alzheimer’s

At a glance: The ONWARDS insulin icodec trials

A round-up of the ONWARDS phase 3 clinical trials evaluating the novel weekly insulin icodec in people with diabetes.
ADVANCED SEARCH
Log in
Top
Annals of Surgical Oncology
Published in: Annals of Surgical Oncology 7/2010

01-07-2010 | Thoracic Oncology

An Evaluation of the Number of Lymph Nodes Examined and Survival for Node-Negative Esophageal Carcinoma: Data from China

Authors: Hao-Xian Yang, MD, PhD, Ying Xu, PhD, Jian-Hua Fu, MD, PhD, Jun-Ye Wang, MD, Peng Lin, MD, PhD, Tie-Hua Rong, MD

Published in: Annals of Surgical Oncology | Issue 7/2010

Login to get access

Abstract

Background

The current American Joint Committee on Cancer (AJCC) staging system for esophageal cancer does not define the minimum number of lymph nodes (LNs) necessary for accurate nodal staging. This study aimed to seek the minimum number of LNs examined for adequate nodal staging of patients with node-negative esophageal cancer.

Methods

We conducted a retrospective review of 592 patients undergoing R0 resection with node-negative esophageal carcinoma between December 1996 and December 2004. The relationship between the total number of examined LNs and death from esophageal cancer was investigated by means of a scatterplot of this variable versus Martingale residuals from a Cox proportional hazard regression model without the variable of interest. A smoothed line fit of the scatterplot was applied to detect the reasonable cutoff point.

Results

The patients were classified into four categories according to the number of examined LNs: ≤5, 6 to 9, 10 to 17, and ≥18. A reduced hazard ratio of death was observed with an increasing number of LNs examined. The 5-year cancer-specific survival rate was 42.8% among patients with ≤5 LNs examined, compared with 52.6, 56.8, and 75% for those with 6–9 LNs, 10–17 LNs, and ≥18 LNs, respectively. Multivariate Cox regression analysis suggested that female sex, lower grade of cell differentiation, lower T category and increasing number of examined LNs were independent factors favoring cancer-specific survival.

Conclusions

At least 18 LNs should be resected for accurate staging of operable esophageal carcinoma. However, a validation from other institute is warranted.
Literature
1.
Sobin LH. TNM classification: clarification of number of regional lymph nodes for pN0. Br J Cancer. 2001;85:780.CrossRefPubMed
2.
Sobin LH. TNM: evolution and relation to other prognostic factors. Semin Surg Oncol. 2003;21:3–7.CrossRefPubMed
3.
Greene FL, Page DL, Fleming ID, et al. AJCC Cancer Staging Manual. 6th ed. Springer, New York; 2002.
4.
Bollschweiler E, Baldus SE, Schroder W, Schneider PM, Holscher AH. Staging of esophageal carcinoma: length of tumor and number of involved regional lymph nodes. Are these independent prognostic factors? J Surg Oncol. 2006;94:355–63.CrossRefPubMed
5.
Chen J, Xu R, Hunt GC, Krinsky ML, Savides TJ. Influence of the number of malignant regional lymph nodes detected by endoscopic ultrasonography on survival stratification in esophageal adenocarcinoma. Clin Gastroenterol Hepatol. 2006;4:573–9.CrossRefPubMed
6.
Dhar DK, Hattori S, Tonomoto Y, et al. Appraisal of a revised lymph node classification system for esophageal squamous cell cancer. Ann Thorac Surg. 2007;83:1265–72.CrossRefPubMed
7.
Greenstein AJ, Litle VR, Swanson SJ, Divino CM, Packer S, Wisnivesky JP. Prognostic significance of the number of lymph node metastases in esophageal cancer. J Am Coll Surg. 2008;206:239–46.CrossRefPubMed
8.
Gu Y, Swisher SG, Ajani JA, et al. The number of lymph nodes with metastasis predicts survival in patients with esophageal or esophagogastric junction adenocarcinoma who receive preoperative chemoradiation. Cancer. 2006;106:1017–25.CrossRefPubMed
9.
Hofstetter W, Correa AM, Bekele N, et al. Proposed modification of nodal status in AJCC esophageal cancer staging system. Ann Thorac Surg. 2007;84:365–73.CrossRefPubMed
10.
Igaki H, Kato H, Tachimori Y, Nakanishi Y. Prognostic evaluation of patients with clinical T1 and T2 squamous cell carcinomas of the thoracic esophagus after 3-field lymph node dissection. Surgery. 2003;133:368–74.CrossRefPubMed
11.
Kawahara K, Maekawa T, Okabayashi K, et al. The number of lymph node metastases influences survival in esophageal cancer. J Surg Oncol. 1998;67:160–3.CrossRefPubMed
12.
Kimura H, Konishi K, Arakawa H, et al. Number of lymph node metastases influences survival in patients with thoracic esophageal carcinoma: therapeutic value of radiation treatment for recurrence. Dis Esophagus. 1999;12:205–8.CrossRefPubMed
13.
Korst RJ, Rusch VW, Venkatraman E, Bains MS, Burt ME, Downey RJ, et al. Proposed revision of the staging classification for esophageal cancer. J Thorac Cardiovasc Surg. 1998;115:660–9.CrossRefPubMed
14.
Kunisaki C, Akiyama H, Nomura M, Matsuda G, Otsuka Y, Ono HA, et al. Developing an appropriate staging system for esophageal carcinoma. J Am Coll Surg. 2005;201:884–90.CrossRefPubMed
15.
Lin CS, Chang SC, Wei YH, et al. Prognostic variables in thoracic esophageal squamous cell carcinoma. Ann Thorac Surg. 2009;87:1056–65.CrossRefPubMed
16.
Mariette C, Piessen G, Briez N, Triboulet JP. The number of metastatic lymph nodes and the ratio between metastatic and examined lymph nodes are independent prognostic factors in esophageal cancer regardless of neoadjuvant chemoradiation or lymphadenectomy extent. Ann Surg. 2008;247:365–71.CrossRefPubMed
17.
Natsugoe S, Yoshinaka H, Shimada M, et al. Number of lymph node metastases determined by presurgical ultrasound and endoscopic ultrasound is related to prognosis in patients with esophageal carcinoma. Ann Surg. 2001;234:613–8.CrossRefPubMed
18.
Peyre CG, Hagen JA, DeMeester SR, et al. Predicting systemic disease in patients with esophageal cancer after esophagectomy: a multinational study on the significance of the number of involved lymph nodes. Ann Surg. 2008;248:979–85.CrossRefPubMed
19.
Shimada H, Okazumi S, Matsubara H, et al. Impact of the number and extent of positive lymph nodes in 200 patients with thoracic esophageal squamous cell carcinoma after three-field lymph node dissection. World J Surg. 2006;30:1441–9.CrossRefPubMed
20.
Wijnhoven BP, Tran KT, Esterman A, Watson DI, Tilanus HW. An evaluation of prognostic factors and tumor staging of resected carcinoma of the esophagus. Ann Surg. 2007;245:717–25.CrossRefPubMed
21.
Wilson M, Rosato EL, Chojnacki KA, et al. Prognostic significance of lymph node metastases and ratio in esophageal cancer. J Surg Res. 2008;146:11–5.CrossRefPubMed
22.
Xiao ZF, Yang ZY, Miao YJ, et al. Influence of number of metastatic lymph nodes on survival of curative resected thoracic esophageal cancer patients and value of radiotherapy: report of 549 cases. Int J Radiat Oncol Biol Phys. 2005;62:82–90.CrossRefPubMed
23.
Eloubeidi MA, Desmond R, Arguedas MR, Reed CE, Wilcox CM. Prognostic factors for the survival of patients with esophageal carcinoma in the U.S.: the importance of tumor length and lymph node status. Cancer. 2002;95:1434–43.CrossRefPubMed
24.
Bogoevski D, Onken F, Koenig A, et al. Is it time for a new TNM classification in esophageal carcinoma? Ann Surg. 2008;247:633–41.CrossRefPubMed
25.
Greenstein AJ, Litle VR, Swanson SJ, Divino CM, Packer S, Wisnivesky JP. Effect of the number of lymph nodes sampled on postoperative survival of lymph node-negative esophageal cancer. Cancer. 2008;112:1239–46.CrossRefPubMed
26.
Rizk N, Venkatraman E, Park B, Flores R, Bains MS, Rusch V. The prognostic importance of the number of involved lymph nodes in esophageal cancer: implications for revisions of the American Joint Committee on Cancer staging system. J Thorac Cardiovasc Surg. 2006;132:1374–81.CrossRefPubMed
27.
Peyre CG, Hagen JA, DeMeester SR, et al. The number of lymph nodes removed predicts survival in esophageal cancer: an international study on the impact of extent of surgical resection. Ann Surg. 2008;248:549–56.CrossRefPubMed
28.
Schwarz RE, Smith DD. Clinical impact of lymphadenectomy extent in resectable esophageal cancer. J Gastrointest Surg. 2007;11:1384–93.CrossRefPubMed
29.
Altorki NK, Zhou XK, Stiles B, et al. Total number of resected lymph nodes predicts survival in esophageal cancer. Ann Surg. 2008;248:221–6.CrossRefPubMed
30.
Rudiger Siewert J, Feith M, Werner M, Stein HJ. Adenocarcinoma of the esophagogastric junction: results of surgical therapy based on anatomical/topographic classification in 1,002 consecutive patients. Ann Surg. 2000;232:353–61.CrossRefPubMed
31.
Grambsch PM, Therneau TM, Fleming TR. Diagnostic plots to reveal functional form for covariates in multiplicative intensity models. Biometrics. 1995;51:1469–82.CrossRefPubMed
32.
Lavernia CJ, Guzman JF. Relationship of surgical volume to short-term mortality, morbidity, and hospital charges in arthroplasty. J Arthroplasty. 1995;10:133–40.CrossRefPubMed
33.
Rice TW, Blackstone EH, Rybicki LA, Adelstein DJ, Murthy SC, DeCamp MM, et al. Refining esophageal cancer staging. J Thorac Cardiovasc Surg. 2003;125:1103–13.CrossRefPubMed
34.
Lin J, Akhter SA, Iannettoni MD. Carcinoma of the esophagus. In: Shields TW, LoCicero J III, Ponn RB, et al, eds. General Thoracic Surgery. 6th ed. Lippincott Williams & Wilkins, New York; 2005. p. 2265–98.
35.
Omloo JM, Lagarde SM, Hulscher JB, et al. Extended transthoracic resection compared with limited transhiatal resection for adenocarcinoma of the mid/distal esophagus: five-year survival of a randomized clinical trial. Ann Surg. 2007;246:992–1000.CrossRefPubMed
36.
Barbour AP, Rizk NP, Gonen M, et al. Lymphadenectomy for adenocarcinoma of the gastroesophageal junction (GEJ): impact of adequate staging on outcome. Ann Surg Oncol. 2007;14:306–16.CrossRefPubMed
37.
Block MI. Transthoracic vs. transhiatal esophagectomy: stage migration muddies the water. J Surg Oncol. 2006;93:519–20.CrossRefPubMed
38.
Veeramachaneni NK, Zoole JB, Decker PA, Putnam JB Jr, Meyers BF. Lymph node analysis in esophageal resection: American College of Surgeons Oncology Group Z0060 trial. Ann Thorac Surg. 2008;86:418–21.CrossRefPubMed
39.
Gordon TA, Bowman HM, Bass EB, et al. Complex gastrointestinal surgery: impact of provider experience on clinical and economic outcomes. J Am Coll Surg. 1999;189:46–56.CrossRefPubMed
40.
Birkmeyer JD, Siewers AE, Finlayson EV, et al. Hospital volume and surgical mortality in the United States. N Engl J Med. 2002;346:1128–37.CrossRefPubMed
41.
Wenner J, Zilling T, Bladstrom A, Alvegard TA. The influence of surgical volume on hospital mortality and 5-year survival for carcinoma of the oesophagus and gastric cardia. Anticancer Res. 2005;25:419–24.PubMed
Metadata
Title
An Evaluation of the Number of Lymph Nodes Examined and Survival for Node-Negative Esophageal Carcinoma: Data from China
Authors
Hao-Xian Yang, MD, PhD
Ying Xu, PhD
Jian-Hua Fu, MD, PhD
Jun-Ye Wang, MD
Peng Lin, MD, PhD
Tie-Hua Rong, MD
Publication date
01-07-2010
Publisher
Springer-Verlag
Published in
Annals of Surgical Oncology / Issue 7/2010
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-010-0948-9

Other articles of this Issue 7/2010

Annals of Surgical Oncology 7/2010 Go to the issue

Gastrointestinal Oncology

Sentinel Node Mapping Guided by Indocyanine Green Fluorescence Imaging During Laparoscopic Surgery in Gastric Cancer

Gastrointestinal Oncology

Serum CA 19-9 as a Marker of Resectability and Survival in Patients with Potentially Resectable Pancreatic Cancer Treated with Neoadjuvant Chemoradiation

Translational Research and Biomarkers

CpG Island Methylator Phenotype Associated with Tumor Recurrence in Tumor–Node–Metastasis Stage I Hepatocellular Carcinoma

Colorectal Cancer

Downstaging Without Complete Pathologic Response After Neoadjuvant Treatment Improves Cancer Outcomes for cIII but not cII Rectal Cancers

Reconstructive Oncology

A Review of the Surgical Management of Breast Cancer: Plastic Reconstructive Techniques and Timing Implications

Translational Research and Biomarkers

Altered Expression of E-cadherin by Hepatocyte Growth Factor and Effect on the Prognosis of Nasopharyngeal Carcinoma